A 55 yo woman with a history of dyslipidemia and an MI 9 months ago has been tak
ID: 127316 • Letter: A
Question
A 55 yo woman with a history of dyslipidemia and an MI 9 months ago has been taking ibuprofen [Advil] for the past 6 months for inflammation around the heart [recommended by cardiologist]. She recently began experiencing epigastric pain and dyspepsia and an ulcer was identified in the duodenum. The urea breath test was negative. She is allergic to penicillin (hives and difficulty breathing) and her SCr is 1.1 mg/dL.
Which of the following regimens would be most appropriate to treat her?
Metronidazole [Flagyl]
Amoxicillin + Clarithromycin [Biaxin] + Lansoprazole [Prevacid]
Omeprazole [Prilosec]
Metronidazole [Flagyl] + Omeprazole [Prilosec] + Clarithromycin [Biaxin]
After completion of the above regimen, it remains necessary that she must continue her ibuprofen [Motrin] as recommended by her cardiologist. Which of the following is the most appropriate medication to be used to prevent NSAID-induced ulcer recurrence?
Omeprazole [Prilosec]
Ranitidine [Zantac]
Celecoxib [Celebrex]
Bismuth subsalicylate
[Pepto Bismol]
Explanation / Answer
Which of the following regimens would be most appropriate to treat her?
The drug regimen to treat her duodenal ulcer includes the following:
Combination of antibiotics to treat H.Pylori + medication to treat acid production
Therefore, the patient can use any one regimen of the following:
Amoxicillin + Clarithromycin [Biaxin] + Lansoprazole [Prevacid]
Or
Metronidazole [Flagyl] + Omeprazole [Prilosec] + Clarithromycin [Biaxin]
Medication to be used to prevent NSAID-induced ulcer recurrence?
Omoprazole is the right drug to prevent the NSAID-induced ulcer recurrence as evidenced in number of studies.
In this half year investigation of 150 patients who were H. pylori-positive, had a current history of NSAID-related ulcer draining and kept on utilizing naproxen, 1 week of H. pylori annihilation treatment was contrasted and long haul omeprazole utilize. Intermittent ulcer draining happened at a rate of 37.6 occasions for every 100 patient-years in the annihilation treatment gathering, contrasted and 8.8 occasions for each 100 patient-years in the omeprazole gathering.
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